Complications following local anaesthetic transperineal prostate biopsies without antibiotic prophylaxis: An institution’s experience

John, Joseph B; MacCormick, Angus; MacDonagh, R.; Speakman, Mark; Vennam, R.; Burns-Cox, Nicholas

doi:10.1177/2051415820987661

Cited by 5 publications

(5 citation statements)

References 15 publications

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“…Similarly, the single-center prospective study by John et al did not report any cases of urinary tract infection over 313 biopsy cases, in which 164 (52.4%) AP was not used. 18 Szabo also reported comparable results in a retrospective series of 242 patients, of whom 212 (88%) did not receive any AP. 15 The author documented no cases of post-biopsy sepsis, although he reported 1 case of delayed perianal abscess (0.4% infection rate).…”

Section: Discussionmentioning

confidence: 61%

Infection Rate after Transperineal Prostate Biopsy with and without Prophylactic Antibiotics: Results from a Systematic Review and Meta-Analysis of Comparative Studies

et al. 2022

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Purpose: We performed a systematic review comparing the incidence of infectious complications following transperineal ultrasound-guided prostate biopsy (TPB) in cases utilizing antibiotic prophylaxis (AP) vs cases not utilizing antibiotic prophylaxis (NAP). Materials and Methods: The incidences of complications were pooled using the Cochran-Mantel-Haenszel method with the random effect model and expressed as risk ratio (RR). RR higher than 1 indicates an increased risk of complication in patients undergoing TPB without antibiotics. Statistical significance was set at p <0.05 and 95% CI. Results: A total of 1,748 papers were retrieved. After the screening process, 8 studies were included in the quantitative analysis (4 retrospective, and 4 prospective and nonrandomized), reporting on 3,662 patients. A total of 2,368 patients underwent TPB utilizing AP and 1,294 underwent TPB utilizing NAP. The pooled rates of post-biopsy fever from 6 available studies reporting this parameter were 0.69% in the AP group and 0.47% in the NAP group (RR: 1.02, 95% CI: 0.02e44.55, p[0.99). The pooled rates of post-biopsy genitourinary infections from 8 available studies reporting this parameter were 0.11% in the AP group and 0.31% in the NAP group (RR: 2.09, 95% CI: 0.54e8.10, p[0.29). The pooled rates of post-biopsy sepsis over 8 studies reporting this parameter were 0.13% in the AP group and 0.09% in the NAP group (RR: 1.09, 95% CI: 0.21e5.61, p[0.92). The pooled rates of post-biopsy readmission for infections over 8 studies reporting this parameter were 0.13% in the AP group and 0.23% in the NAP group (RR: 1.29, 95% CI: 0.31e5.29, p[0.73). Death due to post-biopsy sepsis did not occur in any study. Conclusions: This systematic review found no significant difference in infection rate, fever, sepsis or readmission rate after TPB between those cases utilizing AP and those cases without AP.

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Section: Discussionmentioning

confidence: 61%

Infection Rate after Transperineal Prostate Biopsy with and without Prophylactic Antibiotics: Results from a Systematic Review and Meta-Analysis of Comparative Studies

et al. 2022

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“…No sepsis occurred in men who did not receive antibiotic prophylaxis. Paradoxically, one man (0.07%) with antibiotic prophylaxis developed sepsis who previously experienced septicemia following transrectal ultrasound-guided prostate biopsy [6].…”

Section: Sepsis Rates After Transperitoneal Prostate Biopsymentioning

confidence: 99%

“…those with an indwelling urinary catheter or an immunodeficiency) [4 ▪▪ ]. The second study is a retrospective comparative analysis of complications after transperineal ultrasound-guided prostate biopsy [6]. No sepsis occurred in men who did not receive antibiotic prophylaxis.…”

Section: Evidence Synthesismentioning

confidence: 99%

Transperineal vs. transrectal biopsy to reduce postinterventional sepsis

Stangl‐Kremser

Ramaswamy

2023

Current Opinion in Urology

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Purpose of reviewProstate biopsy is commonly performed in men suspected to have prostate cancer. It has traditionally been performed using a transrectal approach, but transperineal prostate biopsy has been increasingly adopted in part because of its lower associated infectious risk. We review recent studies evaluating the rate of potentially life-threatening post-biopsy sepsis and potential preventive strategies.Recent findingsAfter performing a comprehensive literature search, 926 records were screened and 17 studies published in 2021 or 2022 were found to be relevant. Studies varied in periprocedural perineal and transrectal preparation, antibiotic prophylaxis, and definition of sepsis. The sepsis rates after transperineal ultrasound-guided versus transrectal ultrasound-guided biopsy ranged between 0 and 1 versus 0.4 and 9.8%. Mixed efficacy was found for the topical application of antiseptics before transrectal biopsy to decrease postprocedural sepsis. Promising strategies include the use of topical rectal antiseptics before transrectal prostate biopsy and using a rectal swab to guide the antibiotic selection and the route of the biopsy.SummaryThe transperineal approach to biopsy is increasingly used because of lower associated sepsis rates. Our review of the recent literature supports this practice pattern change. Hence, transperineal biopsy should be offered as an option to all men.

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“…Many recent studies have compared the rates of infectious complications -in particular, sepsisfollowing transperineal biopsy with and without the use of prophylactic antibiotics [1,[27][28][29]31,36,37]. The rates of sepsis and nonseptic infections were less than 0.7 and 2%, respectively.…”

Section: Antibiotic Prophylaxis -Is It Still Necessary?mentioning

confidence: 99%

Developments in optimizing transperineal prostate biopsy

Cheng

Davuluri²,

Lewicki³

et al. 2021

Current Opinion in Urology

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Purpose of reviewProstate biopsy is a very commonly performed office procedure leading to the diagnosis of the most prevalent solid-organ malignancy in American men. Although the transrectal technique for prostate biopsy remains the gold standard, there is increasing interest in the transperineal approach as it offers a clean, percutaneous approach that significantly decreases the risk for infection. In this review, we discuss emerging developments in transperineal prostate biopsy that may optimize the way biopsies are performed in clinical practice. Recent findingsSimilarly, to transrectal biopsy, the transperineal approach also allows for the performance of systematic and MRI-targeted biopsy cores. As transperineal biopsy obviates the translocation of rectal bacteria to the prostate or bloodstream, in contrast to transrectal biopsy, it is feasible to forgo peri-procedural antibiotics in accordance with professional guidelines. This may attenuate antimicrobial resistance that may be associated with augmented prophylaxis. In addition, although transperineal biopsy may be traditionally performed under general anesthesia using a template grid, it may also be performed freehand under local anesthesia or sedation. Avoiding prophylactic antibiotics and general anesthesia as well as reducing infections/hospitalizations for transperineal biopsy scaled nationally will likely result in significant healthcare savings. SummaryTransperineal biopsy with combined systematic and MRI-targeted cores, offers several advantages over conventional transrectal biopsy. Transperineal biopsy under local anesthesia and without periprocedural antibiotic is emerging as a promising method for prostate cancer diagnosis and surveillance.

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Complications following local anaesthetic transperineal prostate biopsies without antibiotic prophylaxis: An institution’s experience

Cited by 5 publications

References 15 publications

Infection Rate after Transperineal Prostate Biopsy with and without Prophylactic Antibiotics: Results from a Systematic Review and Meta-Analysis of Comparative Studies

Infection Rate after Transperineal Prostate Biopsy with and without Prophylactic Antibiotics: Results from a Systematic Review and Meta-Analysis of Comparative Studies

Transperineal vs. transrectal biopsy to reduce postinterventional sepsis

Developments in optimizing transperineal prostate biopsy

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